PROJECT SUMMARY Investigations evaluating the impact of human-animal interactions (HAI) in caring for children with serious, advanced illness and their parents are needed to minimize physical and psychological burdens on individuals and their families. Over 500,000 children and adolescents experience a serious life-threatening condition (LTC) in the United States. Availability of resources to help these children and their families is inadequate. Preliminary data with canine interactions show strong promise to improve outcomes for these vulnerable children. It is crucial now to move the science forward with a rigorous study to examine HAI with a LTC to determine variables contributing to best outcomes of well-being and quality of life. The intervention we developed is designed to provide support and a sense of normalcy in what is often a very frightening place for families. This project will serve as a first step in examining the role of HAI in children with advanced cancer, with a long-term goal of reducing suffering of children with all life-threatening conditions. The overall purpose of the study is to examine feasibility and preliminary efficacy of HAI sessions for children (ages 8-17) with a LTC and their parents., Child-parent dyads or triads will be enrolled in a 1-group pre-and post-test clinical trial. They will participate in HAI sessions each time they come to the children's hospital or clinic, but no more often than once/week. These sessions will take place in a private room with a canine registered with Pet Partners and the canine's owner and will last for approximately 15 minutes. During that time, the child may engage in activities identified by Pet Partners, such as petting the dog, having the dog do tricks, or talking to the dog. A video-recording of the interaction will help determine fidelity and specific activities. Children and parents will complete measures focusing on stress, anxiety, depression and quality of life. Physiologic measures will include saliva samples to test cortisol levels and 24-hour urine specimens for nor-epinephrine. This proposal is well-aligned with PAR-18-650 objectives to support interdisciplinary studies to determine the impact of HAI in and outside the home environment on child and adolescent health and development, as well as therapeutically across the lifespan, through observational studies, experiments, and clinical trials. Results of the study will describe the impact of Human-Animal Interactions on child and adolescent health and have the potential to make a substantial impact on the use of HAI with children with LTC.